States could receive more power over Medicaid

The Trump administration took a significant step Thursday toward letting states set up work requirements for people on Medicaid, the program that covers health care for millions of Americans.

In a 10-page memo to state Medicaid directors, the Centers for Medicare and Medicaid Services said it would support states that want to set up such requirements and it provided guidelines for how to gain approval from the Trump administration.

"Our fundamental goal is to make a positive and lasting difference in the health and wellness of our beneficiaries, and today’s announcement is a step in that direction,” Seema Verma, administrator of the agency, said in a statement.

Ten states have asked for approval for demonstration projects that included work or other requirements, the agency said. Iowa is not among them. But about 600,000 people in the state are covered by the program, which has seen significant changes over the past year as management was turned over to private managed care companies.

Asked whether Gov. Kim Reynolds might pursue a work requirement, a spokesperson, Brenna Smith, said Thursday that "the governor is reviewing and considering the guidelines that just came out today."

"The governor believes that Medicaid is an important safety net for many Iowans, and her hope is that those on the program who are able-bodied are able to find a career and re-enter the workforce. That’s why the governor is introducing the Future Ready Iowa Act, which will provide scholarship and grant dollars for Iowans who want to receive training in high demand fields," Smith said.

The Trump administration's memo, which was released on Thursday, says the move would be aimed at encouraging able-bodied, working age Medicaid recipients to work or get involved in what it called "community engagement." That could include job training, career planning or volunteer activities. Medicaid largely covers the poor and disabled and about 1 in 5 Americans are covered by the program.

The new policy would not apply to people who qualify for the program because of a disability, the memo said.

Still, an official with the advocacy group Disability Rights Iowa expressed concern about the plan on Thursday. Jane Hudson, executive director of the organization, said she is concerned about what would constitute a disability. She also asked, "will a person lose their Medicaid benefits if an employer refuses to provide reasonable accommodations even though it is required by law?"

The Obama administration had declined to offer waivers to states that requested a work requirement.

Conservatives have argued it would ensure Medicaid is only going to the truly needy. The Trump administration memo Thursday said a "growing body of evidence suggests that targeting certain health determinants, including productive work and community engagement, may improve health outcomes."

But critics said this move would take health care away from people who are struggling and it would be counterproductive. "Study after study shows that access to health care translates into higher earnings and better jobs," Winnie Stachelberg, of the Center for American Progress, said.

Currently, about 8 in 10 non-elderly adults who are covered by Medicaid and don't qualify because of a disability live in a working household, and a majority work themselves, according to the Kaiser Family Foundation, a research organization.

A survey Kaiser conducted last year said those who weren't working said it was because of an illness or disability, home or family responsibilities, pursuit of an education, retirement or inability to find a job. Kaiser also said a work requirement is popular. A survey it conducted said 70 percent of Americans support such a requirement.